Presentation
Previous pelvic mesh removal. Complaining of leakage of feces from vagina. No fistula seen on examination.
Patient Data
Volume T2 acquisitions, pre and post introduction of 120 ml of sterile ultrasound gel per anally.
There is no passage of the gel into an ano- or recto-vaginal fistula.
Case Discussion
An MRI enema protocol utilizes the soft tissue resolution of MRI to delineate vaginal and anorectal anatomy, with the luminal gel insertion providing further data regarding the possibility of a fistula track. Multiplanar reformats of the volume T2 sequences aid in image analysis and reporting. The study can be acquired in 20 minutes and avoids the need for radiation from fluoroscopy or CT, of greater importance in younger patients undergoing investigation for obstetric anorectovaginal fistula.
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